Order Form

Billing Information:

__   Mr.       __   Ms.       __   Dr.       __   Mrs.       __   Miss       __   Business

Name (Please print)   __________________________________________________

Address   __________________________________________________________

City   ______________________    State   _____    Zip   ______________________

Phone  (______)__________________(Day)     (______)______________(Evening)

E-mail   ____________________________@______________________________

(Note: Orders may not be shipped to a PO Box. Please provide a street address.)

Shipping Information:

__   Mr.       __   Ms.       __   Dr.       __   Mrs.       __   Miss       __   Business

Address   __________________________________________________________

City   ______________________    State   _____    Zip   ______________________

__   Check here if game is being shipped as a gift.

Gift message, if desired (limit 25 words) : ___________________________________

__________________________________________________________________

__________________________________________________________________

Shipping and Handling add $9.60 per game Continental U.S. (Orders shipped U.P.S. Ground; U.P.S. 2nd Day and Next Day also available - please call; residents of AK, HI and Canada, please call for applicable rates.)

Nebraska residents add 5% sales tax.
Check here if order is placed within Nebraska

Quantity @ $49.95 each = Shipping and Handling Nebraska Sales Tax Total

Payment Method (Please check one; sorry no cash or CODs)

Name on card   ______________________________________________________

Acct#   ____________________________________________________________

Exp. Date   __________________________(Month)_____________________(Year)

Signature   _________________________________________________________